COVID-19 has shed light on the significant and long-standing disparities in underserved communities. Current data still show hospitalization rates among Black and Latinx individuals in the United States are 4 times greater than that of Whites. The Rapid Acceleration of Diagnostics for Underserved Populations (RADx-UP) initiative supports supplements to individual NIH awards to identify the determinants of COVID-19 testing among underserved populations. For this proposal, we will leverage the infrastructure of a NIMHD-funded project in the Family Health Centers (FHCs) of NYU Langone Health, a network of federally qualified health centers in NYC that serves over 125,000 low-income and racially and ethnically diverse patients. In the current application, we propose a three-phase community-engaged study that will employ a multipronged, sequential mixed methods design (i.e., one methodology builds on the findings of the other) to gain a comprehensive understanding of the multilevel factors that drive uptake of testing (and future vaccination) for COVID-19 of Black and Latinx patients (primary outcome), and participation in follow-up care offered by safety-net health systems. Phase 1 will consist of three steps: In step 1, we will leverage a well-characterized electronic health record database (~75% Black and Latinx) to examine differences in the individual-level factors associated with receiving a positive versus negative PCR test for COVID-19 among 400 Black and Latinx patients who receive care at the FHCs. We will also capture the community- and structural-level determinants of testing in this sample using validated self-report measures (e.g., NIH PhenX Tool Kit). In step 2, we will compare these multilevel factors across three patient groups: Group 1- patients who tested positive and received follow-up care and/or services; Group 2- patients who tested positive but did not receive follow-up care and/or services; and Group 3- patients who were eligible for testing (based on symptoms and probable exposure), but did not get tested. In step 3, we will employ predictive modeling to correctly identify patients at high-risk (group 3). In Phase 2, we will combine data from the previous phase with qualitative data (i.e., ethnographic observations, document analyses, and focus groups with FHC staff, providers, administrators, patients and community members) to capture organizational (e.g., FHC staff/provider attitudes and communications with patients, organizational culture) and ethical issues (e.g., data transparency and privacy) to shed light on important social, cultural, and contextual factors associated with uptake of COVID-19 testing and potential vaccine. Finally, in Phase 3, in collaboration with our Community Oversight Task Force, we will integrate Phase 1 and 2 data to refine, test, and disseminate tailored toolkits and ethical governance guidelines (e.g. clinical trials transparency and data privacy). These toolkits will be designed to increase knowledge and awareness of COVID-19 testing and vaccine research and will be widely disseminated among the FHCs, local community, NYULH, and the RADx-UP Coordination and Data Collection Center.
This proposed three-phase mixed methods, community-engaged study is designed to identify multilevel factors that may impede or facilitate COVID-19 testing and anticipated COVID-19 vaccine enrollment among the Federally Qualified Health Centers-treated patient population. This provides an unparalleled opportunity to enroll an ethnically diverse, underserved, high-risk patient population, and if successful, this study will provide the first comprehensive information to shed light on important social, cultural, and contextual factors associated with COVID-19 testing disparities and to help prepare for future testing and vaccine initiatives.